- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.49 / $229.39 / $401.62
| Professional | | $141.49 | $229.39 | $401.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.64 / $276.02 / $450.31
| Professional | | $171.64 | $276.02 | $450.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.11 / $278.58 / $456.16
| Professional | | $178.11 | $278.58 | $456.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,151.20 / $1,831.20 / $2,145.60
| Professional | | $1,151.20 | $1,831.20 | $2,145.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.99 / $285.42 / $524.28
| Professional | | $224.99 | $285.42 | $524.28 |